Impact of perioperative therapy on pathologic response and survival outcomes in hepatoid adenocarcinoma of stomach

Hepatoid adenocarcinoma of the stomach (HAS) is a rare and aggressive subtype of gastric cancer with poor prognosis. This study assessed the significance of perioperative therapy on pathological response and survival outcomes in advanced HAS. A retrospective analysis was performed on 107 HAS patients who underwent gastric cancer surgery with perioperative treatment at our hospital from 2010 to 2025. We identified factors influencing pathological complete response (pCR) and major pathological response (MPR) through comparative analyses. Prognostic factors were determined using Cox regression and Kaplan–Meier analyses. The pCR and MPR rates were 10.3% (11/107) and 20.6% (22/107), respectively. Chemotherapy combined with immunotherapy and four-drug combination regimens significantly improved pCR rates ( p < 0.001). An intensified four-drug regimen achieved pCR in 55.6% of cases. The overall 5-year OS and DFS rates were 74.4% and 71.7%, respectively. Lymphovascular invasion ( p = 0.015) was independent risk factor for poor prognosis of gastric cancer patients. p N stage ( p = 0.015) was independent risk factor for recurrence and metastasis. Perioperative therapy for HAS, particularly immunotherapy and intensified four-drug regimens, can enhance pathological response which highlighting the need for intensified perioperative strategies.